Bridging the Gap Between Pediatric and Adult Care

San Francisco, CA—To decrease barriers to transition for childhood cancer survivors, Children’s Mercy Hospital and the University of Kansas Cancer Center (KUCC), Mercy Hospital, Kansas City, MO, have collaborated to develop the Survivorship Transition Clinic (STC). Integral to the success of the clinic, which launched July 2014 at KUCC, has been a nurse navigator who supports patients at Children’s Mercy as they begin their transition to adult care and meets with them at the STC as they initiate care.

“The nurse navigator has minimized anxiety about transition for patients and parents as she establishes a relationship with patients at Children’s Mercy, and then is able to provide continuity as they transition to the STC at KUCC,” said Joy M. Fulbright, MD, Hematology/Medical Oncology, Children’s Mercy Hospital. “The navigator also improves communication between pediatric providers, adult primary care providers, and subspecialists caring for the patients.”

As she explained at the 2016 Cancer Survivorship Symposium, the importance of transitioning childhood cancer survivors from pediatric oncology care to adult primary care has been acknowledged in literature, but obstacles remain.

“One of the unique challenges of this transition,” said Dr Fulbright, “is that patients are not only leaving oncology, but they are switching from the pediatric care model to the adult care model, where they are expected to take on the onus of their own care.”

According to Dr Fulbright, the cancer survivorship clinic at Children’s Mercy cares for approximately 180 survivors a year, but a third of the survivors are 18 years or older, requiring transition to adult care.

When, in a survey, former patients expressed concern over their current providers’ lack of knowledge regarding late effects, Dr Fulbright and colleagues decided to change the situation.

“We wanted to make sure that our patients and the people caring for them had a greater knowledge about survivorship,” she said. “In addition, at Children’s Mercy, it was always difficult to find a provider to transition our patients to.”

After 2 years of development, the solution arrived in the form of the STC at KUCC, an adult care center, where clinicians would have specific knowledge about how to care for childhood cancer survivors.

“In our discussions,” said Dr Fulbright, “we found that we needed somebody who knew the patients from the pediatric setting in order to create continuity in the adult setting.”

A shared nurse navigator was thus identified as an essential component to a seamless transition, and Dr Fulbright and colleagues were able to obtain philanthropic support for that position.

“The navigator supports patients at Children’s Mercy as they begin their transition,” she said. “The same navigator then meets with the patient at KUCC STC as they initiate care.”

The navigator provides treatment summaries and patient education, and navigates the referral services for survivors. According to Dr Fulbright, however, the greatest benefit has been help with communication and continuity of care so that “patients have a familiar face in both the pediatric world and the adult world.”

Of the 16 survivors since the clinic launched, all have successfully transitioned from pediatric to adult survivorship care, and the feedback has been “remarkably positive.”

“We feel very fortunate that we found a person who fits the role and that we have community support,” she concluded. “It’s been great to see how a pediatric hospital on one side of the state line can work with an adult hospital on the other…and collaborate to help take care of our patients.”